Advice on Taking Malarone
 

For those out there who have taken Malarone/Malaria pills for their African Safari, can you give me some advice on the following...
1. My prescription says take at the same time everyday. What time of the day did you take it?
2. Did you find it better to take the pills before a morning game drive or after dinner in the evening?
3. I'm traveling from Atlanta, Georgia to Amsterdam and then into Nairboi which clearly covers about 2 days...how do you manage the pill on the flight in terms of same time of day?
3. Did anyone out there suffer any side effects while on Safari and if you did how did you stop them?
4. It says to take with food/milk...did anyone out there do that and what did you take it with?
Thanks everyone...we leave in 58 days for our Micato Stanley Wing Safari and can't wait!
Missynole

missy -

There are so many threads on this subject, a search on this board will bring them up.

But
1) Yes, you should take pill same time daily; either morning or evening.
2) If in the morning where you can usually get dairy products, then when you return from morning game drive take with breakfast. If in the evening, then it's evening, so ask for a glass of milk or some cheese with your dinner. While dairy is preferred, I just take with food and have never had any problem.
3) For the "2/days prior", you can take it any time day before you leave (at least to see whether you have some reaction), or take day of departure and then once in Nairobi. Nairobi is not an infected area, so can be considered the second day. Daily thereafter and for 7/days when you return home.
4) No side effects for me. Some do toss it up or get nausea, but I believe instructions are to take another pill "with food" Check with the pharmacist or get the insert.
5) Milk, yougurt, cheese - but I've mostly just taken with food!

I took malarone without any issues (other than the price! if your insurance doesn't cover it, Costco is the cheapest and you do not need to belong to use the pharmacy, fyi).

It took it at the big breakfast after the morning drive. I was the one responsible for handing it out for my group of 3, so no one forgot. You need to start it 2 days before you go into a maleria zone. You will be fine, it is really not a big deal, malarone has the least side effects.

1&2&4) I also just take it with food and don't try to get dairy. Any consistent time has worked fine for me. No pros or cons of any time.

3) As Sandi mentioned, you'll have no malaria threat until after Nairobi so you may not need to factor in jet lag. When I have to account for jet lag, I just do the best I can realizing I am off by a few hours.

3 again) 0 side effects

Have a wonderful trip.

I would strongly suggest taking a week's test dose of Malarone before you go. We had at least two people who had adverse reactions to it on our Tanzania trip (nausea and dizziness.) More than a week after she stopped taking it, my sister is still experiencing those symptoms, as her body doesn't seem to be able to rid itself of the drug. Tests for other causes have been negative.

I just got my prescription for our Oct. trip. I asked for it at my annual physical as did my husband. I had seen a posting that said if you did that, insurance would often cover it.

And...it did!!! Only $25 for a 3 week supply. Not as lucky with the typhoid vaccine. It was $67.

I also had my Hep A & B, tetnus DPT, polio booster. My arm is a bit sore. I will have to wait to see if insurance covers it once I get my bill.

If you have time before your trip, rather than visit a travel clinic, you might want to try getting your prescriptions at your regular check-up

The only script is for Malarone* which you ask for at anytime. Whether it's paid for has to do with whether the insurer covers this med. If they do, they'll cover whenever you need the meds. If not, then not!

*you should also consider Cipro (a tab) requiring a script, in case of bad tummy upset.

The others - Hep A (and/or B, which isn't needed), Polio, Tetanus - are inoculations - all depends on how your doctor records these for the insurer.

My inocs have always been covered under any office visit, not necessarily annual. And my insurer covers my Malarone and Cipro.

Travel Clinic are generally more expensive than your own physician. You can also check with your Public Health Dept, where most of these inocs are available at somewhat lower prices (maybe).

After requesting my insurance to cover Malarone, I got a nice letter in the mail, stating that after I proved I had an active case of maleria, THEN the insurance co. would cover the cost of the Malarone. Needless to say, I paid out of pocket!

betsy -

Goes to show how ineffective our medical insurance providers are. Malarone is taken to help prevent malaria, not to cure it!

O.K. Sandi, I'll bite. I'm a Doc so it's easy to guess my position on medical insurance providers and lawyers :-) I can't defend either the drug industry or the insurance industry either. I can tell you that most insurers will not cover medicines used to prevent diseases not common in the United States. Their reasoning is that travel is at the discretion of the insured and the cost should not be borne collectively, by all of the insured. That is their point of view, not my own. Consider the cost of smoking to the overall costs of the insured. Just want to give you the rationale they (insurance companies) give us Docs in the hope we will explain their case to our patients.
Regards, Chuck

Malarone is also used to treat/cure malaria (but I believe only for those not already taking it as prophylaxis).

<i>For the treatment of adults with malaria, Malarone is given as a single dose of four tablets (total daily dose 1 g atovaquone/400 mg proguanil hydrochloride)for three consecutive days.</i>

http://www.fda.gov/bbs/topics/ANSWERS/ANS01026.html

Patty,
Not so.
Regards Chuck

Chuck,
Not so what? Why would the FDA website say that Malarone is approved for both treatment and prevention with different dosages then?

A more complete explanation is in order here. When treating uncomplicated falciparum malaria (the type found in East Africa) Malarone is the prefered medication. The dosage Patty mentions is correct for adults, children follow a different regimen based upon weight. The only way to confirm malaria is through a laboratory diagnosis. This is difficult while away from home but not impossible. In fact doctors in most third world countries are still trained to make blood smears and treat with a staining compund called gimsea stain. This process shows the malaria parasite inside the blood cell and can be accomplished quickly in the field. Unfortunately U.S. doctors are no longer trained in this procedure (most U.S. medical schools stoped in the mid 1980's because malaria was at such low levels). If malaria like symtoms occur while away from home on safari, I would not hesitate taking the full 4 tablet a day dosage for three days. However, this should never be necessary if you are faithful to the once a day dosing for normal prevention. National Geographic's current issue deals with malaria and in very well written. If you are taking an extended trip or safari, I wouldn't hesitate becoming familiar with recognizing the symptoms of malaria and in taking along enough extra just to be on the safe side.
Regards, Chuck

Patty,
Our post must have crossed but you are quite wrong in your statement or inference that Malarone is not used for treating malaria in patients previously taking it for prevention. It is still the drug of choice in uncomplicated malaria.

safarichuck - since you're a doctor, would you recommend what the above poster mentioned about taking a &quot;test&quot; dose of Malarone for one week before leaving to see what kind of side affects we may feel from the drug? I guess it would be better to see if you're going to have side affects while still in the US vs. feeling that level of uncomfort while in Africa?? Let me know what you would recommend...Thanks

Chuck,
Thanks for the clarification. I couldn't tell what you meant earlier by your two word reply ;) I thought I'd previously read that it wasn't used for treatment when also used for prevention, so thanks for the correction.

Patty,
Sorry to sound so abrupt but I'm only partially retired and had just a few momnets to get onto the computer and get this post off. I'm really happy to see people using the CDC site, it is first rate and more people need to use it. I spent a lot of time while on my own safari seeing patients struck with TD that could have been avoided with just a precaution or two.

Imavolio,
I would not reccommend taking Malarone for a week before departure in hopes of discovering potential reaction. The simple truth (hard to come by on a forum) is that this medication has few side effects and they are insignificant when compared to Larium. The very few people who do show a reaction (my wife is one) don't show it until two or three weeks after starting the medication. So you see how taking it for one full week prematurely can be a bad thing. The most common reaction (and this is rare) is a mild GI upset. Usually this follows taking it on an empty stomach. Another mild reaction is a sore mouth or tongue (canker sores). You can prepare yourself for this by taking along a canker sore medication (sold over the counter) called Zilactin or Oragel. Either one will work just fine. I met another physician in Amboseli last year and his daughter and my wife were both suffereing with canker sores. We decided that if we could get to a chemists, we could put together our own canker sore treatment using glycerin and peroxide. We now carry the medications I mentioned above just in case we need to help a fellow safari traveler. Still it's unusual and it never happened again. malarone is currently your best bet, at least until the current strain of falciparum becomes resistant.
Regards, Chuck

Chuck -

I hear you. After listening to my own physician attempting (almost in tears) to arrange a test for a patient who apparently had a tumor on his head - not just a bump; trying to get the message across to the insurer - most frustrating. It sure would be nice if there was some uniformity amongst insurers. Some cover the meds and inocs and others blatantly refuse. Ugh!

Unfortunately, my Malarone insert, from when the drug first became available in the States (believe '99 or '00) didn't mention Malarone as a treatment, just as preventative. Guess I should get a more current insert... for next trip, I'll ask for one.

Sandi,
Good idea, but it might be more expedient if you google Malarone and go on the Glaxo website. Click on the &quot;prescribing information&quot; link and get your own up to date copy now. After reading it you will know as much as your Doc :-) However, try not and make him/her feel to insecure.
Regards, Chuck